Coronary fast-track activation in STEMI patients: impact on clinical outcomes

Background

ST-elevation myocardial infarction (STEMI) is a major cardiovascular emergency that requires urgent triage for immediate reperfusion therapy, as delays in reperfusion are linked to increased morbidity and mortality. Timely activation of coronary fast-track protocol is critical to minimize ischemic time and improve clinical outcomes.

Purpose

To assess effectiveness of coronary fast-track protocol to door-to-catheterization time and outcomes in STEMI patients.

Methods

Observational, retrospective, single-center study in a tertiary hospital that included all patients admitted with STEMI between September 2023 and September 2025. Activation of coronary fast-track protocol, treatment times, length of stay and in-hospital mortality were evaluated.

Results

A total of 247 patients were included, with 77.7% male individuals, with a median of age of 62 years. Of these, 17 patients presenting with cardiac arrest on admission - triaged directly to the emergency room - were excluded from the statistical analysis. Coronary fast-track was activated in 76.5% of patients presenting with STEMI. It was associated with significantly shorter door-to-catheterization time (median 54 vs. 186 min; p<0.001) and lower total ischemic time (median 244 vs. 357.5 min; p<0.001). Patients without fast-track activation tended to have longer hospitalizations (median 5 vs. 4 days; p=0.085). Regarding left and right ventricular systolic function and left ventricular diastolic function, there were no significant differences between both groups (p=0.257, p=0,275, p=0,069 respectively). In-hospital mortality was nearly four times higher in patients without fast-track to reperfusion therapy (4.3% vs. 15.6%; p=0.006).

Among the patients who were not triaged through the coronary fast-track (n = 45), 57.8% presented with chest pain as the main symptom, which was initially interpreted in triage as not suggestive of acute coronary syndrome.

Conclusion

Activation of coronary fast-track protocol was associated with shorter reperfusion times and significantly lower in-hospital mortality rates among STEMI patients. These findings highlight the importance of systematic triage and objective assessment of chest pain, which should not be subjectively interpreted, to ensure early recognition of STEMI. In addition to improving clinical outcomes, optimized coronary fast-track activation may also reduce hospital length of stay and complications, translating into meaningful organizational and financial benefits for healthcare systems.